The Science of Rheumatoid Arthritis

Question 1

What is rheumatology?

Answer 1

Rheumatology = medial speciality that deals with patients with arthritis and other related conditions

Question 2

What is arthritis?

Answer 2

Arthritis = inflammation of a joint

Question 3

What is the clinical presentation of arthritis?

Answer 3

• Symptoms
  
  • Pain
  • Stiffness
  • Swelling
  • Functional impairment
  • Systemic symptoms
• Signs
  
  • Tenderness
  • Swelling
  • Restriction of movement
  • Heat
  • Red
  • Systemic features

Question 4

What are examples of rheumatic diseases?

Answer 4

• RA
• Sero nergative arthritis
• Crystal arthritis
• Connective tissue diseases
• Systemic vasculitis
• Bone disease
• Osteoarthritis (most prevalent kind of arthritis)

Question 5

What does RA stand for?

Answer 5

Rheumatoid arthritis

Question 6

What is the most prevalent kind of arthritis?

Answer 6

Osteoarthritis

Question 7

What is rheumatoid arthritis?

Answer 7

Rheumatoid arthritis (RA) = chronic, autoimmune systemic illness characterised by a symmetrical peripheral arthritis and other systemic features

Question 8

What can RA be associated with?

Answer 8

• Joint damage
• Disability
• Premature mortality

Question 9

Describe how RA is classified?

Answer 9

Score of 6 or above is needed for classification of patient to deffinitely have RA:

• joint involvement
• serology
• acute-phase reactants
• duraction of symptoms

Question 10

What is the prevalence of RA?

Answer 10

1% of population

Question 11

What sex and age group does RA mostly affect?

Answer 11

• Females > males 3:1
• Age groups 4^th and 5^th decade

Question 12

What is the aetiology of RA?

Answer 12

• Genetic
  
  • Genetic contribution estimated to be about 50%
  • Closes association with specific amino acid sequences at positions 70-74 of DRB1
• Environment
  
  • Smoking
  • Chronic infection
    
    • Such as periodontal disease

Question 13

Describe the pathology of RA?

Answer 13

• Synovitis
  
  • Inflamed synovium
  • Inflamed joint capsule
• Damages surrounding structures
  
  • Cartilage

Question 14

What investigations are done for RA?

Answer 14

• Immunology
  
  • Rheumatoid factor (IgG, IgM)
    
    • Not used anymore
  • Anti-cyclic citrullinated antibodies (anti CCP, ACPA)
• Imaging
  
  • X-ray
  • USS

Question 15

What antibodies are checked to diagnose RA?

Answer 15

• Anti-cyclic citrullinated antibodies (anti CCP, ACPA)

Question 16

What are the clinical features of RA?

Answer 16

• Symptoms
  
  • Pain
  • Stiffness
  • Immobility
  • Poor function
  • Systemic symptoms
    
    • Nonspecific – fatigue, weight loss, anaemia
    • Specific – eyes, lungs, nerves, skin, kidneys
    • Long term – CVS, malignancy
• Signs
  
  • Swelling
  • Tenderness
  • Limitation of movement
  • Redness
  • Heat

Question 17

How many joints are usually inflammed in RA?

Answer 17

With RA usually more than 1 joint is inflamed, normally bilateral (symmetrical polyarthritis)

Question 18

How is the severity of RA assessed?

Answer 18

• Disease severity score (DAS)
  
  • www.das28.com
    
    • DAS <2.4 represents clinical remission
    • SAD >5.1 represents eligibility for biological therapy

Question 19

What does DAS stand for?

Answer 19

Disease severity score

Question 20

What is the main concern in terms of the prognosis of RA?

Answer 20

• Massive impact on work
  
  • About 33% stopped working within 2 years, 50% within 10 years
  • 40 sick days per year instead of average 6.5